PB2093: DIFFUSE LARGE B CELL LYMPHOMA IN THE ELDERLY
Authors: G. Abichou, M. Charfi, O. Kassar, F. Kallel, I. Saguem, W. Feki, I. Ben amor, W. Ben kridis, I. Frikha, L. Khelifa, Y. fakhfekh, N. Toumi, M. Medhaffar, S. Hdiji, T. Boudawara, Z. Mnif, M. Elloumi
Journal: HemaSphere (2022)

Background: Diffuse large B cell lymphoma (DLBCL) primarily affects older patients. In fact, quarter of all DLBCL are over 75 years. The majority of these patients is unfit for aggressive treatment protocols and the lack of randomized trials in this category makes it difficult to choose the best regimen. Aims: The aim of this study is to evaluate the outcome of DLBCL in this category of patients in our center. Methods: We conducted a single-center retrospective study. Newly diagnosed DLBCL patients over 60 years in 2008-2019 treated in the hematology department of Sfax were included. The diagnosis was confirmed according to the WHO Classification of Hematological malignancies. We defined the disease stage according to Ann Arbor staging system. Patients were treated according to the last 2 versions of the national protocol (LNH2008, LNH 2013): patients aged ≤70 years and ≤75 years since 2013 were treated with 6-8 courses of CHOP+/-R and patients aged >70 years (>75 since 2013) were treated with 6 courses of miniCHOP+/-R. We evaluated the response with the International Working Group (IWG) Response Criteria for NHL 1999. We estimated overall survival (OS) and event-free survival (EFS) with Kaplan Meier. Results: A total of 66 elderly patients with DLBCL aged >60 years were identified. Mean age was 71,2 years(61-87). 59% were male. Mean time from diagnosis was 7,7 months. B symptoms were present in 71% of the cases. An altered performans status (≥2) was noted in 50% of the cases. 42 patients had a raised LDH level. The stage of the disease was advanced in 59%. aaIPI was high (≥2) in 27 cases (41%). Nine patients died before treatment (14%). 37 Patients received R+/-CHOP regimen and 20 patients received R+/-miniCHOP regimen. An overall response was noted in 34 cases (60%) with a complete remission in 70% and a partial remission in 30%. Nineteen patients did not achieve the treatment (33%) because of treatment related mortality (TRM) in 10 cases (15%). A hematological toxicity with a grade III/IV neutropenia was noted in 16 patients. Four patients were refractory (7%). Nine patients relapsed (26%). Mean delay from end of treatment was 29 months. Five patients received a platinum-based second-line chemotherapy and 4 patients were unfit for an intensive chemotherapy. Median follow-up of the study was 94 months. 3-year OS and EFS were respectively 60% and 55%. Summary/Conclusion: DLBCL is an aggressive lymphoma of the elderly. The age limit should not be an obstacle for prescribing a chemotherapy. Evaluating the elderly must be using objective tools to distinguish the category of patients unfit for an intensive treatment. In our study, CR rates were lower than the values reported in the literature (56-70%). EFS in our study was 55%, it was comparable to the literature (45-71%). TRM was slightly higher in our study (15% vs <10%). The availability of liposomal Doxorubicin, oral CHOP regimen and Dexrazoxane could change the outcome of this group of patients.